Recent Picture of Infective Endocarditis in Japan

Abstract

on behalf of the CADRE investigators Background: It is important to manage a potentially fatal disease such as infective endocarditis (IE) based on evidence and guidelines for treatment published by academic societies. To clarify the current status of IE in Japan, we conducted a nationwide survey of IE (CArdiac Disease REgistration-Infective Endocarditis [CADRE-IE]). Methods and Results:We collected data on every aspect of IE using web-based survey. Only a Japanese Circulation Society-certified cardiologists who had managed a case of IE could register the patient when the outcome was known. There were 513 cases (320 men, 193 women) from 114 institutions. The median age was 61 years and more than 80% of the patients had underlying cardiac diseases. The majority was valvular heart disease, in which mitral regurgitation was a leading cause. Most of the patients had some predisposing factors, among which, decayed teeth or periodontitis was a leading factor. Streptococci were found in approximately 52% and staphylococci were found in 32% in positive-culture cases. Methicillin-resistant Staphylococcus aureus was found in 7.5%. Congestive heart failure was found in 43% and intracranial complications were found in 31%. Most of the patients were discharged (65%) but in-hospital death occurred in 11%.Conclusions: IE is still a lethal disease affecting older patients. The information obtained from the survey should be very helpful for physicians. (Circ J 2013; 77: 1558 -1564

Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis

“…Furthermore, the overall in-hospital mortality rate was 25% in our ANCA-positive patients with IE, which is higher than the rate of 10% reported in the literature; 37,43,52 it is possible that this discrepancy may be related to: older age and higher prevalence of Staphylococcus infection in our cohort; and low rate of surgery (25%) in our patient, as early surgery is believed to be an effective treatment to decrease mortality in patients with IE. 77–79 In the current study, only in-hospital follow-up, however, was available for our patients. Thus, we cannot exclude that IE patients with ANCA have a decreased late survival; in fact, because of multiple valve involvement, probability of valvular surgery may be higher at long-term follow-up in these patients, leading to increased morbidity and mortality of valvular surgery.…”

Surgical Experience with Infective Endocarditis and Aortic Root Abscess

“…Furthermore, many authors mentioned that the preoperative detection rate of paravalvular abscess with transthoracic echocardiography is very low, and due to surgical complexity, accurate preoperative diagnosis of aortic root abscess is important for proper preoperative surgical planning. Therefore, careful hemodynamic and clinical assessment of these patients with short term trans-esophageal echocardiographic follow up is mandatory to decide the proper timing and plan for appropriate treatment in patients with active aortic valve endocarditis 9,10,11…”

Surgical treatment of aortic valve endocarditis: a 26-year experience

“…Its management aims to eradicate the infecting organism as soon as possible mainly with antibioticotherapy but clinical complications and treatment failure suggest surgery up to 60% of the cases [ 2 ] . IE effecting aortic valve accounts about 40-67% of all cases and about 60-70% of these cases undergo surgery in the acute phase [ 3 ] .…”